MyMedR

Though a common symptom, epistaxis should never be overlooked as the implications may be consequential. Nasal leech infestation represents an unusual etiology of recurrent epistaxis. The leeches release enzymes to anaesthetize the attachment site to facilitate the feeding process. Given the inconspicuous area of infestation and the absence of pain, there is often a delayed treatment. A detailed history taking and physical examination remain paramount in the assessment of recurrent epistaxis.

Paper-thin roof: submucosal cleft palate with rhinolalia aperta

Tuang GJ, Zainal Abidin ZA

Postgrad Med J, 2021 Jul 21.

PMID: 34290122 DOI: 10.1136/postgradmedj-2021-140077

Fulltext Letter to the Editor: "Rosai Dorfman: Rare Cause of Cervical Lymphadenopathy"

Zainal Abidin MR, Tuang GJ, Mansor M

Ear Nose Throat J, 2023 Oct 16.

PMID: 37843046 DOI: 10.1177/01455613231205538

We read with great interest the article by Kobayashi KE et al. published in 2023 entitled: "Presentation of external ear Rosai-Dorfman disease with laryngeal involvement" and wish to reconnoiter Rosai-Dorfman Disease's (RDD) clinical entities and the possible implications from the perspective of otology.

An Unusual Delayed Complication of Rib Graft Microtia Reconstruction After Two Decades: A Case Report

Tuang GJ, Mansor M, Abdullah A

Indian J Otolaryngol Head Neck Surg, 2022 Dec;74(Suppl 3):3671-3674.

PMID: 36742599 DOI: 10.1007/s12070-020-02316-8

Microtia comprises a spectrum of congenital malformation characterized by partial deformities of the auricular components to complete absence of pinna. Surgical reconstructions of this anomaly are often complex and technically challenging. Infection, hematoma, and skin necrosis with resultant exposed cartilage graft tend to occur in the early phase of post-operative care. Herein, we report a case of a spontaneous auricular abscess with exposed cartilage framework 20 years following rib cartilage reconstruction. To our knowledge, this is the first case of such an occurrence. The treatment options are discussed, along with the review of the literature.

Migratory Fish Bone Presented With Extensive Surgical Subcutaneous Emphysema: A Case Report

Muhammad A, Tuang GJ, Zahedi FD, Nik Hussin NR

J Emerg Med, 2021 Jul;61(1):e4-e6.

PMID: 33863569 DOI: 10.1016/j.jemermed.2021.02.022

BACKGROUND: Fishbone ingestion represents a common cause for emergency department (ED) referral. In the majority of cases, an observed fishbone can be easily retrieved in the clinic setting. An impacted fishbone in the throat, albeit uncommon, carries potential risks of life-threatening events. Unusual complications caused by a migrated fishbone, including deep neck abscess, airway obstruction, and major vessels injury, are greatly influenced by the type of ingested fishbone and time between onset and presentation.

CASE REPORT: Here we report an unusual case of surgical subcutaneous emphysema after multiple attempts of purging to remove an ingested fishbone. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Fishbone foreign body is a common presentation to the ED. A thorough history and examination for the migratory foreign body is essential, as the complications are consequential.

Fulltext Unilateral rhinorrhoea and button battery: a case report

Tuang GJ, Nik Hussin NR, Zainal Abidin ZA

Fam Med Community Health, 2019;7(3):e000137.

PMID: 32148716 DOI: 10.1136/fmch-2019-000137

Unilateral rhinorrhoea in the paediatric age group could be an alarming sign that warrants a clinician attention. These patients are routinely brought to see general practitioner as parents may not be aware of the urgency to intervene surgically. Herein we describe a case of a toddler who presented initially to a general practitioner with unilateral nasal discharge. He was subsequently referred to the otorhinolaryngology department for unresolved rhinitis. The child was examined, and the diagnosis of an embedded foreign body was made. X-ray of the paranasal sinus unveiled an embedded button battery. An emergency endoscopic retrieval of the button battery was performed under general anaesthesia. Unfortunately, the case was complicated with a huge septal perforation.

A bleeding throat

Tuang GJ, Liman ARUA, Ramasundram S

Emerg Med J, 2020 Feb;37(2):72-101.

PMID: 31980549 DOI: 10.1136/emermed-2019-209119

Fulltext Plunging Ranula

Liman ARUA, Tuang GJ, Mansor M

Ear Nose Throat J, 2021 Dec;100(10_suppl):1004S-1005S.

PMID: 32525702 DOI: 10.1177/0145561320927828

Case Report: Metastatic Neck Nodes of Unknown Origin with Concurrent Tuberculous Lymphadenitis. Is Fine Needle Aspiration and Cytology (FNAC) Adequate?

Subramaniam SD, Tuang GJ, Zainal Abidin ZA, Abdullah S

Indian J Otolaryngol Head Neck Surg, 2022 Dec;74(Suppl 3):5888-5892.

PMID: 36742794 DOI: 10.1007/s12070-021-02497-w

Presentation with cervical lymphadenopathy would usually have an aetiology of neoplasm, infection or reactive cause. Dual pathology of regional metastasis with simultaneous occurrence of tuberculous lymphadenopathy is rather rare. Herein the authors present a case of primary occult carcinoma and tuberculous lymphadenopathy in an unfortunate patient. The reliability of fine-needle aspiration cytology as a first-line investigation, with alternative methods in approaching cervical lymphadenopathy, was further dissected.

Fulltext An unusual presentation of sphenoid Candida fungal ball: a case report

Tuang GJ, Zahedi FD, Akashah I, Lee JPH, Abidin ZAZ

J Surg Case Rep, 2019 Aug;2019(8):rjz240.

PMID: 31423297 DOI: 10.1093/jscr/rjz240

The clinical presentation of a sphenoid fungal ball (FB) is often non-specific and tends to be overlooked, particularly in hosts with an intact immune status. Rarely, potentially life-threatening complications may arise, owning its anatomical characteristics with contiguous structures. Herein, we present an unusual case of sphenoid FB complicated with orbital apex syndrome in an immunocompetent patient. The diagnosis dilemma and subsequent management are further discussed.

Glial Heterotopia of the Base of Tongue: A Case Report

Tuang GJ, Lee JPH, Velayutham P, Git KA, Ariffin NAA, Abidin ZAZ

Medeni Med J, 2019;34(3):324-328.

PMID: 32821456 DOI: 10.5222/MMJ.2019.88886

Glial heterotopia of oropharynx is a congenital anomaly, whereby ectopic mature glial tissue is found around oropharynx isolated from the brain and spinal cord. Herein we report a rare presentation of a mass at the base of tongue in a neonate. In addition, to underscore the rarity of oropharygeal glial heterotopia, we discuss the dilemma in approaching its diagnosis and management in a neonate.

Fulltext Volumetric evaluation of the sphenoid sinus among different races in the Southeast Asian (SEA) population: a computerized tomography study

Tuang GJ, Zahedi FD, Husain S, Hamizan AKW, Kew TY, Thanabalan J

Int J Med Sci, 2023;20(2):211-218.

PMID: 36794158 DOI: 10.7150/ijms.68095

Introduction: The fundament of forensic science lies in identifying a body. The morphological complexity of the paranasal sinus (PNS), which varies greatly amongst individual, possess a discriminatory value that potentially contributes to the radiological identification. The sphenoid bone represents the keystone of the skull and forms part of the cranial vault. It is intimately associated with vital neurovascular structures. The sphenoid sinus, located within the body of the sphenoid bone, has variable morphology. The sphenoid septum's inconsistent position and the degree, as well as the direction disparities of sinus pneumatization, have indeed accorded it a unique structure in providing invaluable information in forensic personnel identification. Additionally, the sphenoid sinus is situated deep within the sphenoid bone. Therefore, it is well protected from traumatic degradation from external causes and can be potentially utilized in forensic studies. The authors aim to study the possibility of variation among the race, and gender in the Southeast Asian (SEA) population, using volumetric measurements of the sphenoid sinus. Materials and methods: This is a retrospective cross-sectional analysis of computerized tomographic (CT) imaging of the PNS of 304 patients (167 males, 137 females) in a single centre. The volume of the sphenoid sinus was reconstructed and measured using commercial real-time segmentation software. Result: The total volume of sphenoid sinus of male gender had shown to be larger, 12.22 (4.93 - 21.09) cm3 compared to the counterpart of 10.19 (3.75 - 18.72) cm3 (p = .0090). The Chinese possessed a larger total sphenoid sinus volume, 12.96 (4.62 - 22.21) cm3) than the Malays, 10.68 (4.13 - 19.25) cm3 (p = .0057). No correlation was identified between the age and volume of the sinus (cc= -.026, p = .6559). Conclusion: The sphenoid sinus volume in males was found to be larger than those of females. It was also shown that race influences sinus volume. Volumetric analysis of the sphenoid sinus can potentially be utilized in gender and race determination. The current study provided normative data on the sphenoid sinus volume in the SEA region, which can be helpful for future studies.

Fulltext Olfactory impairment in patients with coronavirus disease 2019 self-perceived as asymptomatic

Zahedi FD, Husain S, Wan Hamizan AK, Tuang GJ, Gendeh HS, Oui TJ, et al.

J Laryngol Otol, 2023 Feb;137(2):174-177.

PMID: 35469585 DOI: 10.1017/S0022215121004709

BACKGROUND: Olfactory impairment may be present among patients with coronavirus disease 2019 self-perceived as asymptomatic. This study aimed to assess olfactory function among these individuals.

METHODS: A cross-sectional study involving patients with coronavirus disease 2019 self-perceived as asymptomatic was conducted. Assessments included the subjective Malaysian Smell and Taste Questionnaire and the culturally adapted Malaysian version of the objective Sniffin' Sticks Identification smell test.

RESULTS: In 81 participants (mean age of 31.59 ± 12.04 years), with mean time from diagnosis to smell test of 7.47 ± 3.79 days, subjective assessment showed that 80.2 per cent were asymptomatic (questionnaire score of 6) and 19 per cent had mild symptoms (questionnaire score of 7 and 8). The mean objective smell test score was 10.89 ± 2.11. The prevalence of olfactory impairment was 76.6 per cent among patients with coronavirus disease 2019 self-perceived as asymptomatic. There was no association between the questionnaire and the smell test scores (p = 0.25). There was a correlation between the smell test score and the duration from diagnosis to smell test (p = 0.04).

CONCLUSION: The objective assessment demonstrated that coronavirus disease 2019 patients who perceived themselves as asymptomatic showed olfactory impairment.

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